Covered California II

Enrollment for Covered California began one month ago, and will end on January 15, 2014. The online internet enrollment worked more smoothly and was easy to access. It functions fairly well and most of the time it proceeds without a hitch.

One problem I encountered was an inability to progress from {adding members}  to where the web page for adding new members. This attempt repeated itself a number of times when 'next' was selected. After several attempts the next page did appear, and the process proceeded without further difficulty.

The people who receive the 'best benefits/premium cost' are clearly in the Medi-Cal category if their income is at or below the poverty level. The web site performed fairly well with numerous pop-ups and drop down menu selection. Because of the relatively large number of selections and fields it was difficult to scan through deductibles, and/or co pays. The site allowed users to select and compare plans by checking the plans one wanted to compare.

The plans all have deductibles and co pays. The lower the premium the higher the copay and and deductible.  In many cases the insurance appears to be 'catastrophic coverage'  Common sense would make one wonder how many people could afford a deductible of $2500 to $10,000.

The financial algorithm was  designed by people who know little about health care or it's real expenses.  It seems the design was to fit health care into the budget process.

Jonathan Gruber, the principal economic adviser and designer is an expert in health economics at the macro level, and is no authority on patient care.  He has no medical experience or clinical credentials and is ignorant of patient-provider health process.  He had received numerous awards in healthcare economics.
Gruber has published more than 140 research articles (the majority of which were for NBER) and has edited six research volumes.^[11] He is a co-editor of the Journal of Public Economics, an associate editor of the Journal of Health Economics, and the author of Public Finance and Public Policy.^[12] In 2011, he wrote Health Care Reform: What It Is, Why It's Necessary, How It Works, a graphic novel delineating the Affordable Care Act, illustrated by Nathan Schreiber.^[2]

An allegation and video content of Gruber testifying in several resulted in an eruption of public outrage and discontent.

In January 2010, after news emerged that Gruber was under a $297,000 contract with the Department of Health and Human Services, while at the same time promoting the Obama administration's health care reform policies, some conservative commentators suggested a conflict of interest.^[18][19][20] Paul Krugman in The New York Times^[21] argued that, although Gruber didn't always disclose his HHS connections, the times when he didn't were no big deal. 

In November 2014, a series of videos emerged of Gruber speaking about the ACA at different events, from 2010 to 2013, in ways that proved to be controversial. Many of the videos show him talking about ways in which he felt the ACA was misleadingly crafted and/or marketed in order to get the bill passed, while in some of the videos he specifically refers to American voters as ill-informed or "stupid." In the first, most widely-publicized video taken at a panel discussion about the ACA at the University of Pennsylvania in October 2013, Gruber said the bill was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money." He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage.

Writings:

Gruber's published works include:

• On February 15, 2006, the Center on Budget and Policy Priorities published an article by Gruber entitled "The Cost and Coverage Impact of the President's Health Insurance Budget Proposals"^[13]
• In a December 4, 2008, New York Times op-ed, "Medicine for the Job Market", he claimed that expanding health insurance, even in difficult financial times would stimulate the economy.^[14]
• On February 9, 2011, the Center for American Progress published an article by Gruber titled "Health Care Reform Without the Individual Mandate," analyzing the health insurance coverage impacts of alternative policy options for encouraging purchase of health insurance under the Patient Protection and Affordable Care Act, including the mandate, a late penalty, and auto-enrollment.^[15]

Covered California web site illuminates the copay/deductible inverse relationship and premium subsidy.  The working of Obamacare  obfuscates the ACA bill which was passed by the Democratic party.  Very troubling is  it did not include Republcan legislators in the design process. 

Contrary to Obama's proclamations many patients did not keep their physician,or hospital. Nancy Pelosi's uncannily accurate comment 'we won't know what is in it until we pass it'. Jonathan Gruber's "stupid" must also mean 'congress' was too stupid as well.

Portions of this article are attributable to 

New York Times, Covered California (online enrollment)

Obamacare, Is the American Public Stupid or were they Deceived....Again

According to government sources, Obamacare is a resounding success. Yet industry experts and pundits examining the implementation say otherwise.

More information is forthcoming about ObamaCare. Jonathon Gruber, Professor of Economics at M.I.T a primary author for the Affordable Care Act was interviewed by

the Daily Motion (video)

He was a key architect of both the 2006 Massachusetts health care reform, sometimes referred to as "Romneycare", and the 2010 Patient Protection and Affordable Care Act, sometimes referred to as "Obamacare".^[1]

Sen. Rand Paul (R-Ky.) made a guest appearance on “Hannity” Monday and said that embattled Obamacare architect Jonathan Gruber should be made to give back the money he received for his work on the health care bill.

ObamaCare Architect Thinks You’re Stupid; Pelosi Does Too

Gruber admitted multiple times that Obamacare was written in a non-transparent way intentionally, to exploit the “stupidity” of the American voter.

Real Health Care Reform Should be Affordable

The average Floridian pays way too much for health care. Roughly, 18 percent of your income goes towards your health care, on average. Now research from Harvard shows that health care spending will grow faster than the economy for at least the next 20 years.

The Affordable Care Act was supposed to prevent this, but it cannot. Rather than reform health care, the law merely expanded health insurance, a costly system that leaves patients behind and is largely responsible for spiraling costs.

What Geometry Can Teach Us


 Insurance Plan Reimbursement                                      Patient--Provider Payments    

Think back to your eighth-grade geometry class. You probably learned that the shortest path between two points is a straight line. You can apply this same logic to spending, where the cheapest option involves only two parties. In health care, the two parties that matter are you and your health care provider (your doctor, the pharmacy, etc.). You spend the least money when you pay them directly. onsider how health insurance works. Your money exchanges hands multiple times before it reaches the provider. It first goes to a third party (either the insurance company or the government, such as in Medicare and Medicaid). From there, those entities negotiate compensation schedules with providers and facilities. Both of these steps add bureaucratic and administrative costs to health care’s price tag. And although insurers attempt to lock in reasonable prices on your behalf, they often come up short.Why? Because they’re not spending their money: They’re spending yours. They thus have less of a financial incentive to get the best deal. Businesses and bureaucrats are no different from you and me; if you give them someone else’s money, they’re more likely to spend it foolishly.
***********************************************************************************************************************

Now consider how health insurance works. Your money exchanges hands multiple times before it reaches the provider. It first goes to a third party (either the insurance company or the government, such as in Medicare and Medicaid). From there, those entities negotiate compensation schedules with providers and facilities. Both of these steps add bureaucratic and administrative costs to health care’s price tag. And although insurers attempt to lock in reasonable prices on your behalf, they often come up short.

Why? Because they’re not spending their money: They’re spending yours. They thus have less of a financial incentive to get the best deal. Businesses and bureaucrats are no different from you and me; if you give them someone else’s money, they’re more likely to spend it foolishly.

The same problem affects you once you have health insurance. After you pay your premiums, insurance gives you the illusion that you’re spending someone else’s money. The health insurance trap thus comes full circle, both insurers and consumers make it more expensive.

This raises the question: If not “Obamacare,” what else? Reformers should start by giving consumers the freedom to make their own health care choices. We need to return health insurance to the role of taking care of unpredictable, catastrophic health care expenses, and leave the great majority of everyday health care decisions in the hands of consumers.

We know this works. In the fields of cosmetic surgery,  lasik eye surgery , alternative medicine, and dentistry, the absence, or minimal presence, of government regulation or health insurance has driven prices down, and quality and service up. This has occured due to these procedures being elective, and requirement for out of pocket payment  by the patient.

Doctors can also refuse to take health insurance. More doctors and hospitals are choosing this path. One of my patients did this and saved $17,000 on a single procedure.

Lawmakers should encourage this kind of patient-focused innovation. Instead, they gave us “Obamacare,” which wraps health care in red tape and forces everyone to purchase health insurance. Real reform shouldn’t leave us with a higher bill.

Dr. Jeffrey Singer practices general surgery in Phoenix and is an adjunct scholar at the Cato Institute.

WHY AMERICA IS LOSING THE HEALTH RACE

Article attributed to:  New Yorker Magazine

Many Americans are aware that the United States spends much more on health care than any other country in the world. But fewer people know that the health of Americans—by many different measures—is actually worse than the health of citizens in other wealthy countries.

Two major reports, both released last year, provide further elaboration of this apparent paradox. The first, “The State of US Health, 1990-2010,” documented trends in mortality and morbidity across the thirty-four member countries of the Organization for Economic Cooperation and Development (O.E.C.D.). The study, published in The Journal of the American Medical Association (to which I am a contributing writer), showed that both life expectancy and healthy-life expectancy improved in the United States over two decades. But the pace of those improvements was considerably slower in the United States: in 1990, the U.S. ranked twentieth among O.E.C.D. countries for life expectancy, and fourteenth for healthy-life expectancy; by 2010, it had fallen to twenty-seventh and twenty-sixth, respectively. The other charts and tables in the report—about heart, lung, and kidney disease; diabetes; injuries and homicides; depression; and drug abuse—all show Americans suffering poorer health.

The second report, commissioned by the National Institutes of Health, and conducted by the National Research Council (NRC) and the Institute of Medicine (IOM), convened a panel of experts to examine health indicators in seventeen high-income countries. It found the United States in a similarly poor position: American men had the lowest life expectancy, and American women the second-lowest. In some ways, these reports were not news. As early as the nineteen-seventies, a group of leading health analysts had noted the discrepancy between American health spending and outcomes in a book called “Doing Better and Feeling Worse: Health in the United States.” From this perspective, the U.S. has been doing something wrong for a long time. But, as the first of these two reports shows, the gap is widening; despite spending more than any other country, America ranks very poorly in international comparisons of health. The second report may provide an answer—supporting the intuition long held by researchers that social circumstances, especially income, have a significant effect on health outcomes.

Americans’ health disadvantage actually begins at birth: the U.S. has the highest rates of infant mortality among high-income countries, and ranks poorly on other indicators such as low birth weight. In fact, children born in the United States have a lower chance of surviving to the age of five than children born in any other wealthy nation—a fact that will almost certainly come as a shock to most Americans. But what causes such poor health outcomes among American children, and how can those outcomes be improved? Public-health experts focus on the “social determinants of health”—factors that shape people’s health beyond their lifestyle choices and medical treatments. These include education, income, job security, working conditions, early-childhood development, food insecurity, housing, and the social safety net.

Steven Schroeder, the former president of the Robert Wood Johnson Foundation—the largest philanthropic organization in the United States devoted to health issues—had a definitive answer to my question about why Americans might be less healthy than their developed-country counterparts. “Poverty,” he said. “The United States has proportionately more poor people, and the gap between rich and poor is widening.” Seventeen per cent of Americans live in poverty; the median figure for other O.E.C.D. countries is only nine percent. For three decades, America has had the highest rate of child poverty of any wealthy nation.

Steven Woolf, of Virginia Commonwealth University, who chaired the panel that produced the NRC-IOM report, also pointed to poverty when I asked him to explain the causes of America’s health disadvantage. “Could there possibly be a common thread that leads Americans to have higher rates of infant mortality, more deaths from car crashes and gun violence, more heart disease, more AIDS, and more premature deaths from drugs and alcohol? Is there some common denominator?” he asked. “One possibility is the way Americans, as a society, manage their affairs. Many Americans embrace rugged individualism and reject restrictions on behaviors that pose risks to health. There is less of a sense of solidarity, especially with vulnerable populations.” As a percentage of G.D.P., Woolf observed, the U.S. invests less than other wealthy countries in social programs like parental leave and early-childhood education, and there is strong resistance to paying taxes to finance such programs. The U.S. ranks first among O.E.C.D. countries in health-care expenditures, but as Elizabeth Bradley, a researcher at Yale, has documented, it ranks twenty-fifth in spending on social services.

The NRC-IOM report emphasized the effect of social forces on children and how those forces carry over to affect the health of adults, noting that American children are “more likely than children in peer countries to grow up in poverty” and that “poor social conditions during childhood precipitate a chain of adverse life events.” For example, of the seventeen wealthy democracies included in the report, the U.S. has the highest rates of adolescent pregnancy and sexually transmitted diseases, and the second-highest prevalence of H.I.V. This platform of adverse health influences in childhood sets up the health disadvantage that remains pervasive for all age groups under seventy-five in the United States.

It seems likely that many Americans would respond to these figures—and to the role poverty plays in poor health outcomes—by assuming that the data for all Americans is being skewed downward by the health of the poorest. That is, they understand that poor Americans have worse health, and presume that, because the United States has more poor people than other wealthy countries, the average health looks worse. But one of the most interesting findings in the NRC-IOM report is that even white, college-educated, high-income Americans with healthy behaviors have worse health than their counterparts in other wealthy countries.

Woolf explained this disparity by citing the work of the British social epidemiologist Richard Wilkinson, who has proposed that income inequality generates adverse health effects even among the affluent. Wide gaps in income, Wilkinson argues, diminish our trust in others and our sense of community, producing, among other things, a tendency to underinvest in social infrastructure. Furthermore, Woolf told me, even wealthy Americans are not isolated from a lifestyle filled with oversized food portions, physical inactivity, and stress. Consider the example of paid parental leave, for which the United States ranks dead last among O.E.C.D. countries. It’s not hard to see how such policies might have implications for infant and child health.

Other countries have used their governments as instruments to improve health—including, but not limited to, the development of universal health insurance. Health-policy analysts have therefore considered the effect that different political systems have on public health. Most O.E.C.D. countries, for example, have parliamentary systems, where the party that wins the majority of seats in the legislature forms the government. Because of this overlap of the legislative and executive branches, parliamentary systems have fewer checks and balances—fewer of what Victor Fuchs, a health economist at Stanford, calls “choke points for special interests to block or reshape legislation,” such as filibusters or Presidential vetoes. In a parliamentary system, change can be enacted without extensive political negotiation—whereas the American system was designed, at least in part, to avoid the concentration of power that can produce such swift changes.

Whatever the political obstacles, a major explanation for America’s persistent health disadvantage is simply a lack of public awareness. “Little is likely to happen until the American public is informed about this issue,” the authors of the NRC-IOM report noted. “Why don’t Americans know that children born here are less likely to reach the age of five than children born in other high income countries?” Woolf asked. I suggested that perhaps people believe that the problem is restricted to other people’s children. He said, “We are talking about their children and their health too.”

The superior health outcomes achieved by other wealthy countries demonstrate that Americans are—to use the language of negotiators—“leaving years of life on the table.” The causes of this problem are many: poverty, widening income disparity, underinvestment in social infrastructure, lack of health insurance coverage and access to health care. Expanding insurance coverage under the Affordable Care Act will help, but pouring more money into health care is not the only answer. Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.

Self-interest may be a natural human trait, but when it comes to public health other countries are showing the U.S. that what appears at first to be an altruistic concern for the health and care of the most vulnerable—especially children—may well result in improved health for all members of a society, including the affluent. Until Americans find their way to understanding this dynamic, and figure out how to mobilize public opinion in its favor, they will all continue to lose out on better health and longer lives.

Allan S. Detsky (M.D., Ph.D.) is a general internist and a professor of Health Policy Management and Evaluation and of Medicine at the University of Toronto, where he was formerly physician-in-chief at Mount Sinai Hospital. He is a contributing writer for The Journal of the American Medical Association.

Photograph by Ashley Gilbertson /VII.

Taxpayers subsidizing 76% of premium under health care law Associated Press

Healthcare.gov  If you missed signing up, here are some other alternatives

People who signed up for coverage under President Obama's health care law are paying about $80 a month in premiums on average, the administration reported Wednesday.


The new numbers from the Health and Human Services Department cover only the 36 states where the federal government took the lead in setting up new insurance markets, accounting for about 5.4 million of the 8 million people who signed up nationally.

Among the major findings:

-- Taxpayers are subsidizing 76 percent of the average monthly premium in the 36 federally administered markets.

-- The average premium is $346 a month, but the typical enrollee pays just $82. Tax credits averaging $264 a month cover the difference. The government pays the subsidy directly to insurers.

-- After tax credits, Mississippians paid the least for coverage - averaging just $23 a month on average premiums of $438. Among people in the 36 states, New Jersey residents paid the most - an average of $148 on premiums averaging $465 a month.

-- For this year, the average consumer could pick from five insurance companies and 47 different plans, although choice was more limited in a small number of states. From a range of platinum, gold, silver and bronze plans, most people picked silver.

-- There was a link between greater competition and lower premiums. For each additional insurer in a local market, premiums for the benchmark silver plan declined by 4 percent.

-- Premiums varied widely between states, ranging from an average of $536 in Wyoming to $243 in Utah.

Federal officials say they don't yet have complete data on the 14 states running their own markets.

Affordable Care Act------Silk Scarf or Pig's Ear ?

Silk Scarf or Pig’s Ear ?

President Obama and the Democrats insist that the Affordable Care Act is working and has increased the number of insured, yet most Americans do not like the law.

The question now is what kind of bang did we get?  

Figures from the Heritage Foundation in their Consumer Power  Report “Obamacare Squandered $1.2 Billion on Failed Exchanges

It all began when HBX was enrolling carriers for each state. At best it was a difficult sell with much arm-twisting   In Maryland, Mississippi, New Mexico, and South Dakota, officials had to beg and plead just to get one carrier into the state’s private market.

Continuing problems are ongoing in many state exchanges. There’s only one insurance carrier – Blue Cross Blue Shield – in West Virginia’s exchange.

Hawaii is another consensus pick, and some experts say the state might never be able to support its Obamacare exchange. Hawaii was near the bottom for total enrollment, signing up just 15 percent of its eligible population, and had the second-worst mix of young adults. The state’s exchange also suffers from the fact that Hawaii had a low uninsurance rate to begin with – meaning there’s a smaller pool of potential customers there, which makes the state less attractive to insurers. Hawaii’s “Health Connector” has signed up the smallest number of people of any state in the country and has no plans to finance their operations moving forward. Their current plan appears to be to all-but-close-up-shop and outsource all of the exchange functions to the state Department of Human Services. The state’s leading insurance company says it is time to pull the plug. Expect this one to be official any day now.

Health care analysts are also keeping an eye on premiums in Maryland, Mississippi, New Mexico, and South Dakota, where officials had to beg and plead just to get one carrier into the state’s private market.

The expected rise in premiums will vary greatly from state to state, smaller states with fewer enrollees and a bias toward older and sicker people will see sharp rises in premiums.  It’s impossible, though, to say with any certainty whether a particular state will see an above-average price increase next year.   Maryland, Mississippi, New Mexico, and South Dakota,  are among those HBXs to watch.   Minnesota’s exchange has been a disaster, and they recently brought in [Deloitte] on a nine-month $4.95 million contract to fix it. It is unclear whether they will be successful.

Vermont, the tiny state with giant ambitions to use Obamacare as a stepping stone to single-payer, government-run health care is still facing enormous problems dealing with its tiny population. They are using CGI, the same vendor that failed on the federal healthcare.gov, and have given them a deadline of July 2 to get the site working. It is unclear what Vermont will do if they fail to deliver by that date.

The total is $ 1.2 billion…..and it is not over, yet

The Future Just Passed

Things are changing quickly, at first it was little things like you are now a primary care provider instead of a GP or Family Physician. Today I read that we are now First Level Providers , or Second Level Providers instead of a specialist. What's in a name....?  Everything. Nomenclature often defines the culture, and new vocabulary and abbreviations change the way we think, write and do.

I am now lumped in with "Vision Care Providers"....which seems to lump me in with Opticians, and Optometrists.   One thing I was always challenged with is the relative lack of sophistication and/or knowledge as to the difference between and O.D. (Optometrist) and M.D. (Ophthalmologist).  In recent years Optometrists become certified in therapeutics for treatment of some eye conditions.  The threshold for medical treatment has been lowered substantially.

Health Reform iinvolves both quantity and quality of health care. During the most recent decades there are many who argue that quantity does not equate with quality of care.  Measuring quality is challenging at to where to look.  Recent ideas include better outcomes (ostensibly measured by the number of reductions in readmission after hospitalization within the first 30 days of discharge.  That metric however encompasses a small measure of health delivery.

The  outpatient, or ambulatory service setting presents the majority of health expense and visits, save for long term care of the aged population.

The affordable care act will markedly increase outpatient services for states who have opted-in for medicaid expansion.  This will be covered in an upcoming edition.

Enrolled in Covered California...Have insurance? Think Again

Even hardcore supporters of the affordable care act are speaking publicly about the shortcomings and misdirections of the Afffordable Care Act…  and the necessity to modify the law.  Still there is much resistance to repealing the law.

The enrollment process is somewhat easier, however the choices are still a challenge. It is stragiht forward on selecting your level of eligibility.  Choosing plans is more of a challenge, especially if some of the information is incorrect such as providers, hospitals and other service providers.  

Enrollment data is beginning to accumulate, however there have been no public announcements regarding payment of premiums, nor analysis of types of policies.

The selection process is important. For some levels the copays and deductibles are very high. Although  premiums  appear to be low in some cases patients will need to be prepared to spend substantial portions of their income for medications, copays for laboratory, imaging and other testing.  For those who are relatively healthy and do not ‘consume’ much in the way of health care it won’t be a burdern.   For those who have chronic and/or serious illness who may need to be seen three or four times in a month….say a newly diagnosed diabetic, (they may be faced with four provider copays amounting to $160.00 and other copays for labs and/x-rays. Add this to the premium, and the monthly payment rises.  For those on subsidies this additonal burden on a modest income is significant.

For those who are euphoric about finally obtaining insurance coverage some will be surprised to find all is not well and the plans fall short of ‘guarranteeing’ health care for them.  A challenge will be finding a provider who accepts affordable care act plans.   It is going to require 12 months or more to feret out the good from the bad policies.  

Providers are on the line as well. Many high deductible policies will place hospitals at risk, when their patients cannot afford a deductible of 10,000-12,000 dollars. This will require cost shifting to balance the equations, and will not alleviate some medically induced bankruptcies.

PPACA AND OUTPATIENT PROCEDURES

HealthCare LeadersMedia expects the Affordable Care Act to cause the number of outpatien proceures to increase for those opted-in for Medicaid expansion in the PPACA. And according to figures there is a spread seen as examined by state.   By 2015 California stands to perform 46 million outpatient procedures, while a state such as Texas (opted-out for Medicaid expansion) will decrease by 53 million cases.  (reported by Truven Health Analytics)   

These figures are further broken down by specialty. Two specialties which create a significant number of ambulatory surgeries, and among the top tier of expense are cardiology and orthopedics.  Medicaid opt-in vs opt-out produces some signifcant differences in reimbursement that outweigh numbers of cases.  The split per  specialty mirrors that of the total number gained or lost in 2016.  

Mental health services (Psychiatry) are already in short supply and  have previously been throttled by the lack of reimbursement by insurers.  PPACA has mandated an increase in these services as a covered benefit. For those states who are opted out the medicaid eligible population will suffer relative to states opted-in. Those who live in states opted-out of Medicaid expansion will not have access to insured  care for outpatient psychiatry services.

As expected the variance is greatest for California and Texas which are outliers in the data. In 2016 the volume of Cardiology cases in Califonia will increase by 672,000, while Texas will forgo 840,000 cases.  These figures also reflect population differences and the number of medicaid eligible patients in each state.

For orthopedic surgery California (opted-in) will benefit from over 299,000 outpaitent orthopedic cases, while states such as Florida and Texas (opted-out) stand to lose near 300,000 orthopedic cases.

The choice to opt-in vs opting out not only effects who will receive benefits in the eligible  population but will have significant effects on the hospital industry.  The number of outpatient surgerie outweighs the number of inpatient surgeries.  Using the present fee for service reimbursement rates under FFS hospitals have been advantaged by higher reimbursement reflected by higher cost.  The loss of coverage for medicaid eligible patients not only places them in jeopardy, it also creates significant differences in the infrastructure necessary to deliver these services.

Outpatient services in states who have opted-in will need a business plan to expand capacity which includes not only physical plant, but skilled workers, such as surgical techs, surgeons, expendables as well as revising operating schedules, reducing turn-a-round times and the like.

DME suppliers will reap these benefits in opt-in states.

The figures represent the number of cases gained vs the loss of gain by opting out. The opt-out numbers are a speculation, and do not represent an actual decrease in cases.  The number of procedure in any case will not decrease in states that have opted-out.

Increased demand for services always encourages efficiency and technical breakthroughs, to decrease loses and encourage profitability, much as occured with small incison cataract surgery and the development of small incision surgery in cardiology,general surgery and orthopedic surgery.

While ‘futurists’ attempt to predict the effects of the new law, serendipity and the butterfly effect should be expected.

This article also appears in Health Train Express, February 22, 2014. http://healthtrain.blogpot.com

The author also publishes at Digital Health Space http://digitalhealthspace.blogspot.com

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Affordable Care Act..Obama admits "THERE MAY BE STRUCTURAL PROBLEMS.

...Hinges No Longer Squeak, They Are off the Doors....  California today announced the expansion of customer service agents for COVERED CALIFORNIA.

CoveredCA is hiring an additional 350 telephone agents to meet the continuing demand to enroll for Covered California. The California Medical Association also reported; Health Reform and Covered California News

The White House is relaxing the employer mandate again 

The Treasury Department on Monday rolled out more tweaks to the health-care law's requirement that all large employers--those with 50 or more workers--provide insurance coverage to their workers. This is the part of Obamacare was supposed to take effect at the start of 2014, but was delayed by the White House this past summer as the White House was facing significant push back from employers.

Covered California is hiring more workers to fix service problems

California's health insurance exchange is racing to fix persistent service problems before it faces another surge of Obamacare applicants eager to beat a March enrollment deadline. The state is drawing on a $155-million federal grant it received last month to improve service ahead of the March 31 sign-up deadline under the Affordable Care Act. The Obama administration is counting on California to deliver another big wave of enrollment to compensate for a shaky rollout nationwide.

350 workers added to Covered California call lines
Hundreds of customer service representatives will be added to Covered California’s phone lines, to help cut wait times and to enroll more state residents into health care plans before a March deadline, state officials announced Monday

California health exchange pulls doctor directory again

California's health insurance exchange pulled its online doctor directory again after some physicians were wrongly listed as accepting patients' coverage plans, spurring a blame game between insurers and providers. A major error was made in the provider directorty for private insurers Covered California published the incorrect list of providers.  Many have not signed up to be providers under California law.  Covered California requires a different set of rules including unique reimbursement rates. Many providers do not even know they are llisted, and when they present themselves to the MDs office they will find the doctor' office unable to accept them.

For 3 million, 'affordable' health care might not be
The lure used to get uninsured Americans to sign up for health law coverage was the promise of generous premium subsidies.The promise comes with a catch for almost 3 million people earning three to four times the federal poverty rate: They may have to pay up to 9.5% of their income toward that premium before the government subsidy kicks in. That could take a substantial bite from their budgets — potentially as much as $600 a month for a family of three earning $58,590 to $78,120. As a result, some middle-class families may decide health insurance is beyond their reach and pay a penalty rather than buy coverage.